A nurse is teaching a client who has a new colostomy about how to control odors and flatus.
Which of the following instructions should the nurse include?

Choice A rationale

Measuring the client's legs with a tape measure is the correct action to ensure proper sizing of the antiembolic stockings. Correct sizing is critical for effective venous compression and to prevent complications such as skin irritation, tissue damage, or impaired circulation. Stockings that are too tight can act as a tourniquet, while those that are too loose will not provide the necessary graduated compression to facilitate venous return and prevent blood stasis, which is the underlying cause of deep-vein thrombosis. This precise measurement ensures the stockings fit snugly and provide optimal therapeutic benefit.

Choice B rationale

Removing the stockings every 24 hours is an insufficient interval for skin integrity checks and to allow for proper cleaning and assessment. The standard practice involves removing antiembolic stockings at least twice daily for a short period. This allows the nurse to inspect the client's skin for any signs of pressure, irritation, or breakdown, and to perform hygiene. Prolonged, continuous wear without breaks can compromise skin integrity and increase the risk of developing pressure injuries, especially in a client who is less mobile due to their condition.

Choice C rationale

Folding the stockings at the top is a harmful and dangerous practice. Folding creates a constrictive band around the client's leg, which acts as a tourniquet. This constriction impedes venous and lymphatic return, leading to increased risk of blood stasis, edema, and tissue damage. The pressure from the folded band can severely compromise circulation and potentially worsen the client's underlying deep-vein thrombosis. The stockings should be smooth and wrinkle-free to provide uniform graduated compression.

Choice D rationale

Massaging the legs of a client with deep-vein thrombosis (DVT) is contraindicated and can be extremely dangerous. Massaging can dislodge the thrombus (blood clot) from the venous wall. If the clot becomes dislodged, it can travel through the bloodstream, leading to a pulmonary embolism (PE), a life-threatening condition where the clot obstructs a pulmonary artery in the lungs. Therefore, any form of massage or direct pressure on the affected limb is strictly avoided to prevent this potentially fatal complication. *.

Choice A rationale

Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior. Individuals with this disorder often feel uncomfortable when not the center of attention and may use dramatic, theatrical, or seductive behaviors to attract others. They are not typically withdrawn or anxious in social settings.

Choice B rationale

Avoidant personality disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The client's statements of becoming "extremely anxious in social gatherings" and never feeling "good enough" for coworkers are hallmark symptoms of this disorder. They actively avoid social situations to prevent rejection.

Choice C rationale

Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control. Individuals with this disorder are often rigid and inflexible. They are not typically described as being socially anxious due to feelings of inadequacy, but rather due to a need for control.

Choice D rationale

Borderline personality disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, and marked impulsivity. While individuals with this disorder may experience intense anxiety and fear of abandonment, their core features are related to instability, not a pervasive feeling of not being "good enough" in social settings. .